Contouring of the left anterior descending coronary artery in patients with breast cancer – the radiation oncologist’s view

Breast cancer is the cancer with the largest prevalence, both in Poland and worldwide. The standard treatment in patients with this disease is breast-conserving therapy (BCT), followed by whole breast radiotherapy (WBRT) with a boost dose applied to the area of the bed created after tumour resection. In women who have undergone breast amputation – in the presence of poor prognostic factors – the chest wall is irradiated with or without the irradiation of the axillary fossa and clavicular area. Radiotherapy is used as an adjuvant treatment in connection with the high rate of relapses in the area of the treated breast – as much as 20% after 10 years. Some patients, before the commencement of the irradiation, are treated systemically with the use of regimens comprising drugs with a high degree of cardiotoxicity. This effect may even be increased during the course of radiotherapy – mainly in patients after amputation of the left breast. The side-effects induced by radiotherapy depend on area of the heart within the field of irradiation. Studies suggest that the vulnerable parts of the heart are the coronary vessels, and primarily, the left anterior descending (LAD) artery, which is located close to the chest wall. The objective of this study is to present practical guidelines concerning contouring the left anterior descending (LAD) artery in patients with cancer of the left breast, who have qualified for radiotherapy. Contouring the LAD seems to be significant as a method of assessing the critical organ during radiotherapy. The results may cause a modification of the treatment strategy: a change to the planned radiotherapy, the quantity of the beams and/or their angle of incidence or a change in the beam weight

Repeated radiotherapy in a patient with a vaginal recurrence – a case report

A recurrent disease may assume the form of a local relapse within the area of the removed tumor (or in the uterus after radiotherapy) or in the neighborhood through extension of the neoplastic process or metastasis. Recurrences are asymptomatic in approximately 30% of patients and diagnosed during a routine check-up. In 35–40% of patients, vaginal bleeding is the first symptom, whereas 16% of women complain about pelvic pain. It must be remembered that urinary disorders may also be the first manifestation of a local recurrence. Until recently, patients with recurrences in a previously irradiated site were not candidates for a repeated radiotherapy mainly because of organs at risk, and more precisely – because of the dose deposited in these organs during the primary treatment. Currently, the dynamic development of new planning and treatment techniques using external-beam radiation makes it possible to consider re-irradiation in selected cases. However, planning and conducting such a treatment is difficult and time-consuming. It requires highly specialized radiotherapy techniques and an individual approach. This article presents a patient with a disease recurrence in the vaginal stump after comprehensive treatment and discusses elements that need to be taken into consideration for repeated radiotherapy to be planned and conducted

Possibilities of using radiotherapy in the treatment of vaginal recurrence in patients with uterine cancers

A major problem in cancer treatment is disease recurrence, i.e. a situation in which the standard procedures turned out to be ineffective and the previously used therapy significantly limits its next use. Vaginal recurrence is found in 2.4–15% of patients with uterine cancer. For large recurrent tumors radical treatment involves surgical pelvic exenteration. However, indications for this procedure are significantly limited; in addition, it is associated with a high risk of complications and a significantly compromised quality of life. For this reason, brachytherapy and/or another course of radiotherapy are administered, which until recently were used as a further-line treatment option or as palliative care. Over the last few years extension of indications for radiotherapy and brachytherapy has been noted due to the dynamic development of new techniques for planning and conducting treatment. These allow for the irradiation of the target volume which causes radiation-related reactions that are acceptable for the patient while protecting critical organs. The introduction of new therapeutic devices allowed for the use of different treatment techniques, including intensity-modulated radiation therapy, image-guided radiotherapy, RapidArc, tomotherapy, intraoperative radiotherapy and stereotactic body radiotherapy, which contributed to a significant increase in the role of repeat radiotherapy. One needs to remember about the possibilities of systemic treatment, although it is usually palliative in nature. Brachytherapy may be considered for the treatment of recurrent disease if the lesions are located in the region of the vagina or vaginal stump or if infiltration is found in the parametria; in other situations treatment combined with external beam radiotherapy should always be considered. The choice of brachytherapy method depends on the location of the lesion and the extent of infiltration. If the infiltration is up to 5 mm deep, intracavitary brachytherapy is performed. If the infiltration is deeper, the use of interstitial brachytherapy is indicated

Przerzuty do wątroby u chorych z czerniakiem gałki ocznej

Ocular melanoma is associated with increased risk of liver metastases. The mean survival is only between 2–11 months after diagnosis. We describe 5 patients with liver metastases of ocular melanoma, only 1 patient being asymptomatic at the time of diagnosis. The most patients are diagnosed too late, so followup should include abdominal ultrasonography and liver enzymes.U chorych na czerniaka oka występuje duże ryzyko przerzutów przede wszystkim do wątroby. Średnie przeżycie po rozpoznaniu zmian w wątrobie nie przekracza 2–11 miesięcy. W niniejszej pracy przedstawiono 5 przypadków chorych, u których rozpoznano czerniaka oka, tylko u 1 osoby przebieg był bezobjawowy, zdiagnozowany na podstawie wykonanych badań kontrolnych, pozostałe osoby zgłaszały niepokojące objawy kilka miesięcy przed potwierdzeniem zmian przerzutowych w wątrobie. Zaawansowane stadium choroby w momencie potwierdzenia diagnozy wskazuje na fakt, że konieczna jest stała kontrola narządów miąższowych i enzymów wątrobowych

Side effects of postoperative radiotherapy in patient with laryngeal cancer receiving immunosuppressive drugs after renal transplant recipient

Radioterapia stanowi ważną opcję terapeutyczną w leczeniu raka krtani, zarówno jako leczenie uzupełniające, jak i leczenie radykalne, jednakże u chorych po przeszczepie nerki może być trudna do przeprowadzenia. Autorzy opisują przypadek 63-letniego mężczyzny, po przebytej operacji radykalnej krtani z powodu raka, skierowanego do uzupełniającej radioterapii. Na podstawie wyniku badania histopatologicznego ustalono stopień zaawansowania guza na T2N0M0. W wywiadzie 3 lata wcześniej u pacjenta przeprowadzono zabieg przeszczepienia nerki od zmarłego dawcy; od tamtej pory przyjmował leczenie immunosupresyjne. Po włączeniu radioterapii zaobserwowano nadmierny odczyn popromienny błony śluzowej jamy ustnej. Wysoki odczyn popromienny (15 pkt wg skali Dischae) utrzymywał się, pomimo 2-tygodniowej przerwy w napromienianiu i wymagał leczenia objawowego. Z powodu długiej przerwy w radioterapii, po konsylium lekarskim, podjęto decyzję o zakończeniu leczenia. Chory otrzymał łączną dawkę 26Gy z zaplanowanej dawki 60Gy. Aktualnie, półtora roku od zakończenia radioterapii, pacjent czuje się dobrze, jest pod stałą kontrolą nie stwierdza się nawrotu choroby.Radiotherapy is an important option for laryngeal cancer treatment, both as an adjuvant and a radical procedure; however, in patients after renal transplantation it may be difficult to carry out. The authors describe a case of a 63-year-old man with a history of radical surgery for cancer of the larynx, ordered to undergo adjuvant radiotherapy. In the postoperative histopathological examination the patient was diagnosed with cancer stage T2N0M0, and radical surgery was performed. As per anamnesis, three years earlier the patient underwent renal transplantation from a deceased donor; since then he received immunosuppressive therapy. After radiotherapy had been included, excessive post-radiative reaction was observed in the oral mucosa. High treatment toxicity (15 Dische score) persisted despite a two-week break in radiotherapy, and symptomatic treatment was necessary. Due to a long interruption of radiotherapy, after a medical consultation a decision was made to terminate the treatment; instead of the planned 60Gy, the patient received 26Gy. Currently, eighteen months after the radiotherapy, the patient is in good condition and the follow-up examinations have shown no evidence of recurrenc

The analysis of the level of Treg lymphocytes in the blood of patients with endometrial cancer before and after the surgery — preliminary study

Introduction. The progression of cancer is a complex process involving host-tumour interactions taking place in cancer and in the cancer microenvironment. The tumour remodels the microenvironment into the suppressive profile by various mechanisms. One of the most important elements of this mechanism is the inducing of the infiltration of Treg lymphocytes into cancer and its microenvironment. The aim of the present study was to evaluate the alterations of the Treg cell population in the peripheral blood of patients before and after the surgical treatment for endometrial cancer. Material and methods. For the present study 24 patients with endometrial cancer were recruited. All the patients were treated surgically. The peripheral blood samples were collected from the endometrial cancer patients before operation and three days after the surgical procedure and evaluated using flow cytometry method. Results. CD25+ CD4+ FOXP3+ T cells were found in all the examined peripheral blood samples derived from the endometrial cancer patients in the days before and following applied surgery. We observed differences before and after the applied surgical procedure in patients treated for uterine cancer. The highest number of Treg cells in the peripheral blood was demonstrated before the surgical procedure; it diminished statistically significantly following the surgery. Conclusions. The decrease of the percentage of Treg cells in blood sera in patients following radical surgical treatment might be useful in measuring the radicalism of the treatment. The monitoring of the level of selective immune system suppression related to Treg cell blood serum levels during cancer therapy might support a decision to supplement the standard therapy with immunotherapy or to increase the degree of radicalism of the applied therapy.

Analysis of Treg cell population in patients with breast cancer with respect to progesterone receptor status

Breast cancer is the most frequently diagnosed type of cancer in women worldwide. Both the development and progression of breast cancer are related to tumour evasion of the immune system through a process called cancer immune-editing, in which regulatory lymphocytes play an important role. The infiltration of Treg cells in patients with breast cancer has been proposed as an independent unfavourable prognostic factor. In the present study, we aimed to evaluate the percentages of the Treg cell populations in the peripheral blood of patients with breast cancer with respect to progesterone receptor expression. Peripheral blood samples were collected from 27 patients with breast cancer treated in the Clinical Department of Breast Cancer and Reconstructive Surgery of the Professor Franciszek Lukaszczyk Oncological Centre, Bydgoszcz. Flow cytometry was used to evaluate the percentage of CD25+/ FOXP3+/CD127 (–/low) T cells within CD3+/CD4+ T cells. The presence of CD25+/FOXP3+/ CD127 (–/low) T cells within CD3+/ CD4+ T cells was identified in all the examined blood samples. A statistically significantly higher percentage of CD25+/FOXP3+/CD127 (–/low) T cells within CD3+/CD4+ T cells was observed in progesterone receptor (PR)-negative breast cancer patients when compared to PR-positive breast cancer patients. The observed high percentage of CD25+/FOXP3+/CD127 (–/low) T cells within CD3+/CD4+ T cells in PR (–) breast cancer patients when compared to PR (+) breast cancer patients seems to confirm the unfavourable prognostic significance of these cells in breast cancer patients. This may indicate a rationale for combining standard oncological treatment in breast cancer patients with Treg-depleting therap

An analysis of outcomes, after re-irradiation by HDR (high-dose-rate) brachytherapy, among patients with locally recurrent nasopharyngeal carcinoma (NPC)

BackgroundDespite aggressive treatment with radiotherapy, which is often combined with chemotherapy, local persistence occurs in 18–40% of patients with nasopharyngeal carcinoma. Brachytherapy is one of the methods for the re-treatment of patients with locally recurrent nasopharyngeal carcinoma.AimThe aim of this paper was to evaluate the effectiveness of HDR (high-dose-rate) treatment of patients with locally recurrent nasopharyngeal carcinoma.Materials/MethodsThe study took the form of a retrospective analysis and included a group of 28 patients treated in the Brachytherapy Department of the Oncology Centre in Bydgoszcz during the years 1995–2000. Brachytherapy was carried out using a Rotterdam applicator and the MicroSelectron HDR apparatus produced by Nucletron. Irradiation was based on doses of 36 Gy, i.e. 6 Gy applied once a week, and 51 Gy i.e. 3 Gy applied twice a week. This paper presents recovery probability, overall survival and recurrence-free survival within the analysed group of patients.ResultsThe results obtained prove intracavitary HDR (high-dose-rate) brachytherapy to be a viable method for the treatment of patients with recurring nasopharyngeal carcinoma.ConclusionsThe higher the total dose applied by means of brachytherapy, the greater the chance of locally successful treatment, moreover, the time that elapses before recurrence is considered to be an important factor influencing recurrence-free survival time